OCD and autism are distinct conditions, but they share some similar symptoms. On the surface, OCD (Obsessive-Compulsive Disorder) and autism spectrum disorder (ASD) might seem like entirely separate conditions. However, there are several intersections between these two conditions. Let’s look at this overlap and how these repetitive behaviors can significantly impact daily life.
The Overlap Between OCD and ASD
Repetitive behaviors
Both OCD and ASD involve repetitive thoughts, movements, or speech. For those with OCD, these repetitions are unwanted and intrusive, while for those with ASD, they can be comforting or self-stimulating. Either way, repetitive behaviors can significantly impact daily life.
Difficulty with change
Whether it’s a change in routine, environment, or activity, many individuals with OCD or ASD struggle with transitions and unpredictability. They tend to prefer strict schedules, familiar surroundings, and repetitive tasks. Unannounced changes can lead to anxiety, distress, and meltdowns.
Restricted interests
Some people with OCD or ASD develop very focused interests in specific topics, objects, or activities. They may spend much time reading, talking, or thinking about their interests. These restricted interests can be enjoyable but also limit openness to new experiences. The overlap between OCD and ASD is complex, but understanding their relationships can help inform diagnosis and treatment.
Common Obsessions and Compulsions in Individuals with Autism
It’s common for those with autism to develop obsessions and compulsions, especially in childhood. Repetitive behaviors like lining up toys, flipping light switches, or repeating words or phrases are common. These behaviors may seem odd to others, but they do provide some comfort.
Restricted interests are intense interests in specific topics, objects, or activities. Someone may amass an encyclopedia’s worth of knowledge on trains, astronomy, or the weather. While interest-based learning benefits development, restricted interests can be all-consuming, causing problems with socializing and learning other things. Providing opportunities to engage with interests in moderation and redirecting focus when needed helps establish balance.
Rigid thinking involves strict rules and routines that must be followed to feel in control or avoid distress. Examples are needing to sit in the same seat, taking the same route to school, or eating foods in a specific order. Encouraging flexibility and coping strategies for when the familiar isn’t possible helps build resilience.
Social difficulties like lack of eye contact, personal space issues, and trouble understanding social cues are common in autism. Explicitly teaching social skills through role play, social stories, modeling and counseling can help. However, it’s important to accept that some level of social difficulties may always remain, but that successful, meaningful and healthy relationships can still form for most people on the spectrum.
Effective Treatment Options for Co-Occurring OCD and Autism
It is common for OCD and Autism to both be present for someone. The most effective treatments for co-occurring OCD and autism focus on behavioral and cognitive interventions. Cognitive behavioral therapy (CBT) is one of the leading treatment options.
Cognitive Behavioral Therapy (CBT)
Exposure and Response Therapy: Traditional CBT helps challenge obsessive thoughts and compulsive behaviors while teaching coping strategies to manage symptoms. CBT may
need to be adapted to accommodate sensitivities for those on the spectrum. Exposure and response prevention (ERP) is a specific CBT technique where individuals are exposed to anxiety-provoking triggers while preventing compulsive behaviors. This helps desensitize obsessive fears and breaks the cycle of compulsive relief-seeking.
At Spencer Psychology, our clinicians are trained in both traditional exposure therapy for OCD, and a new cutting-edge Inference Based CBT for OCD (I-CBT). Obsessive Compulsive Disorder: CBT and Inference-Based CBT – Spencer Psychology
Understanding Inference-Based CBT
Inference-Based Cognitive Behavioral Therapy (I-CBT) is a newer approach that focuses on how these doubts are formed in the first place. Instead of focusing on the behaviors themselves, I-CBT helps people understand the thinking traps that lead to obsessive fears. It’s like learning how the “OCD voice” convinces the person that something bad might happen—even when there’s no real evidence. I-CBT teaches that OCD is rooted in mistaken reasoning. For example, someone might know their stove is off, but still feel unsure because their mind creates a “what if” scenario. I-CBT helps people recognize when they’re relying on imagination or possibility instead of reality. Through guided sessions, clients learn to spot these thinking errors, challenge them, and shift their focus back to what they can actually observe. Over time, this reduces the power of obsessive thoughts and the need to perform compulsions. It’s a hopeful, empowering approach that helps people trust themselves again.
Applied behavior analysis (ABA)
ABA focuses on learning and development. ABA therapists use reinforcement techniques to teach adaptive behaviors and skills. ABA can help reduce repetitive behaviors, improve social skills, and increase independence in those with ASD. For co-occurring conditions, ABA may incorporate strategies to target OCD symptoms specifically.
Medication
Medication is sometimes used to supplement behavioral therapies. Selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Lexapro, the typically the first line of treatment for OCD, and may help reduce obsessive-compulsive symptoms in individuals on the spectrum.
Our Autism Specialists:
Melissa Hinkle, LCSW – Spencer Psychology (children)
Bree Russo, LCSW, RPT-S – Spencer Psychology (children)
Tiffany Leonard, LMHC – Spencer Psychology (college students and adults)
Brianna Swenson-Brack, LMHC, RPT – Spencer Psychology (children)
Lexie Carlson-Wheat, LMHC – Spencer Psychology (older teens and adults)
Our OCD Specialists:
Linda Kranitz, PhD, HSPP – Spencer Psychology (adults and traditional CBT)
Robert Lee, PsyD HSPP: (adults and traditional CBT)
Mindi Wisker-Tindall, LMHC: (older teens/adults with both traditional CBT and Inference-Based CBT)
Tiffany Leonard, LMHC: (teens/adults with both traditional CBT and Inference-Based CBT)
Melissa Hinkle, LCSW: (children/adolescents and traditional CBT)
Bri Cha, LCSW: (adults and Inference-Based CBT)
If you or someone you love struggles with both OCD and autism, know that we are here to assist you make sense of it all and help you find good treatment strategies. Contact our office to book your first appointment.
Author: Jennifer Spencer, PhD, HSPP is the owner of Spencer Psychology, and a licensed psychologist with over 30 years of experience in mental health counseling in Bloomington IN. Spencer Psychology is committed to providing compassionate expert care in-person and by telehealth for Bloomington, the surrounding area and by telehealth for all of Indiana.